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Exposed: ‘secretive’ NHS cost-cutting plans include children’s care

Cancer diagnostics and treatment for children with complex needs are among services earmarked for cost-cutting plans considered by the NHS to plug a funding gap, according to documents seen by campaigners.

The plans, by South Gloucestershire clinical commissioning group and released under a freedom of information request, show that waiting targets for non-urgent operations are also due to be relaxed under the “capped expenditure process” (CEP) as the health service seeks to balance its books in the current financial year.

The proposals are the latest example of what critics have condemned as “draconian” measures that NHS care providers in 13 large areas of England are being told to push through, said the campaign group 38 Degrees, which obtained the documents.

They detail £5m of additional cuts to local services in South Gloucestershire as part of CEP, which is run by national NHS regulators and aims to find £250m of savings by rationing services.

Cancer diagnostics, neurological rehabilitation and children’s continuing care policy for those with complex needs arising from disability, accident or illness, are listed for proposed savings by the South Gloucestershire CCG. It aims to make a total of £4,839,000 in extra savings under CEP. The bulk could be made by “reduction in RTT [referral to treatment] performance”, which would lead to longer waiting times, and reduction in independent sector treatment centre activity.

The crowdfunded group 38 Degrees said the proposals were the first to be revealed under FOI. The doctors’ union, the British Medical Association, which has been frustrated in its attempts to gain information about the CEP through FOI requests, has previously accused NHS bosses of shrouding the process in “totally unacceptable secrecy”.

Leaked proposals from three other areas have already revealed plans including downgrading or closing A&Es and extending waiting time for operations.

Holly Maltby, a campaigner at 38 Degrees, said: “These plans shed light on just how seriously patient care in South Gloucestershire could be affected. They also begin to paint a picture for how services in other areas of England are likely to be hit too – with cancer treatment and children in need affected.”

More than 245,000 people have signed a 38 Degrees petition calling for full public disclosure on each of the 13 regions being forced to make deeper cuts. “The NHS belongs to all of us, so all of us should get a say in any changes to our local services,” said Maltby.

The 13 regions, which are among those expected to record some of the service’s biggest deficits, have been instructed by NHS England and NHS Improvement to “think the unthinkable” to balance the books. Originally they were told to make £500m of savings by March 2018, later reduced to £250m.

The South Gloucestershire CCG is part of the Bristol, North Somerset and South Gloucestershire sustainability and transformation partnership (STP). The South Gloucestershire savings amount to £4.8m, which is roughly a quarter of the £17.2m savings required from the whole STP.

The Guardian revealed in June the threat of closures and increased waiting times under proposals to save £183m across five London boroughs under the CEP programme. There is also concern that cancer treatment may be delayed if the NHS in Cheshire reduces the number of diagnostic endoscopies it undertakes by 25%, and that patients in east Surrey and Sussex may be denied angiograms and angioplasty surgery as part of the CEP savings drive.

The president of the Royal College of Paediatrics and Child Health, Prof Neena Modi, said: “The UK has previously been a champion of fair and equitable cost-containment, so secretive decisions on which services to stop providing are both surprising and unacceptable.

“Transparency is essential around what each service costs the taxpayer, what proportion of public monies go to frontline care and what proportion is wasted on the profit margins of non-NHS providers. The public has a right to know the basis on which decisions are made. These should demonstrably be based on principles of equity, efficiency and should include consultation with healthcare staff and the families of children that will be affected.

“Without such transparency there will inevitably be even greater disquiet at the erosion of children’s services at a time when metrics of children’s healthcare in the UK is a recognised cause of national concern.”

NHS England was approached for comment.

Fighting the flu can be a matter of life and death – so what more can we do?

As Australia endures one of its worst flu seasons in more than a decade, questions are being raised about how the public can be better prepared and what can be done to protect the most vulnerable.

At least 170,000 influenza cases have been confirmed this season, almost two-and-a-half times more than in 2016. The federal health department logged 72 flu-related deaths by Thursday, including that of eight-year-old Rosie Andersen in Melbourne. Experts say Australia is on track for a record number of confirmed cases.

Sarah Hawthorn, from the regional town of Cobram in northern Victoria, remains in a critical condition in hospital after contracting the flu late in her pregnancy. After giving birth to a healthy boy, she was placed in an induced coma.

Despite tragic cases such as these, the spike in flu cases is a pattern that plays out globally every 10 to 15 years. The difficulty with influenza viruses is that different viruses circulate the population each year that may not be covered by current flu vaccines, and those viruses that are covered can mutate, a phenomenon known as viral drift, making the vaccinations against them less effective. Vaccines also remain effective for only one season.

Unlike other vaccines that are more than 95% effective at protecting against a specific disease when a full dose is administered – for example, the chickenpox and polio ones – the flu vaccine is, on average, only 40% protective, although this varies depending on the flu strain. By comparison, staying home from work when suffering the flu, hand-washing, and covering one’s mouth when coughing and sneezing protects against spreading the disease 68% of the time.

Leading infectious diseases expert Dr Peter Collignon has called for better identification of patients suffering bacterial infections secondary to the influenza virus.

Collignon, a professor of microbiology and a medical doctor, who has worked with the World Health Organisation and as a government adviser, says the rise in the number of cases could also be because laboratory tests to diagnose influenza are improving almost every year. But he says the current peak in cases should not come as a surprise.


The vaccine for H3N2 basically didn’t work and was zero per cent effective for those over 65

Dr Peter Collignon

“The strain we are predominantly seeing this year is influenza A strain H3N2, and this is the same strain that hit last winter in the UK and other European centres and caused problems there,” Collignon says.

“What they found in those countries was that the vaccine for H3N2 basically didn’t work and was zero per cent effective for those over 65. So maybe you could say it was predictable we would see similar issues in Australia this season.

“The thing is, yes, influenza knocks a lot of people around but most recover, have only mild infections, and some don’t even suffer symptoms. Basically, we need a better vaccine, but that’s tricky because it’s a difficult virus that changes all of the time.”

Given the vaccine’s lack of efficacy and mutations of flu strains, Collignon says more research and funding needs to be directed towards identifying those most at risk of dying once they have the flu.

While it is well known that pregnant women, those over the age of 65 or in nursing homes, children under five and those with chronic conditions such as heart or lung disease are more susceptible to the flu, Collignon says monitoring these groups alone will not necessarily allow doctors to pinpoint those at risk of death.


Death seems to especially affect those who got sick, got better, then got sick again

Dr Peter Collignon

“The majority of people die not of the influenza but due to secondary bacterial infections,” he says.

“Of the children who die after contracting the flu, they find golden staph as a complication in a lot of them. One of the things the flu perversely does is set up the throat to become ripe for bacterial infection. Death seems to especially affect those who got sick, got better, then got sick again.”

This is important because these bacterial infections can usually be treated with antibiotics. But routinely treating people with antibiotics without knowing if they have had a bacterial infection, can lead to antibiotic resistance, Collignon says.

“Only 1 or 2% of those with flu get these secondary infections, so we must get better at identifying them and identifying them early,” he says. “That’s where we need more research, and education, so that parents know if their child gets sick for a few days from the flu, then seems to get better and then worse, they should get their child treated.”

In the case of influenza-related deaths, hospitals should record the course of illness and whether the symptoms seemed to improve for a time, he says.

He emphasises the importance of those in higher-risk groups getting the vaccine, including pregnant women, who can get immunised for free under the national immunisation program.

“Even 30% or 40% protection against going to hospital is better than nothing,” Collignon says.

Australia’s health minister, Greg Hunt, has asked the chief medical officer, Professor Brendan Murphy, to ensure that all aged care workers are properly vaccinated. There is no mandatory requirement for this at present.

“I will work with the medical authorities, healthcare workers and the aged care providers on how we can make it compulsory for those working in aged care facilities,” Hunt says.
“We cannot continue to have a situation where people whose immunity is already low are at risk from others who may be infected.”

Overstretched hospitals face winter flu crisis, doctors warn

Emergency departments risk “grinding to a halt” this winter, say medical leaders. They warn that the number of patients facing long waits for treatment is likely to hit record levels.

Dr Taj Hassan, president of the Royal College of Emergency Medicine, said staff were dangerously overstretched, as NHS figures showed the number of people waiting more than 12 hours for treatment during the coldest months of the year has soared.

From January to March 2012, 15 patients waited for more than 12 hours – in 2017 this figure was 100 times greater, at 1,597.

Last winter was the worst on record for delays, with nearly 200,000 patients waiting for longer than the four-hour target. Hassan said emergency services will be under even greater strain this year, with patients forced to wait longer for basic treatments such as pain relief.

“Winter last year was relatively mild and without a major outbreak of flu. There are indications that the flu vaccine will not be as successful this year and as such we anticipate that conditions will be even more difficult,” said Hassan. Simon Stevens, chief executive of NHS England, has already put hospitals on high alert following major flu outbreaks in Australia and New Zealand, which it is feared may be repeated in the UK.

An extra 5,000 beds are needed to “to get us through what will be a pretty awful winter”, said Hassan. “Over the last five years there has been a continued reduction in bed numbers yet an increase in patients needing to be admitted. As a result, bed occupancy is now at 92% – significantly higher than the safe level of 85% – which is having a knock-on effect on waiting times.”

A lack of funding, especially in social care, and staff shortages are preventing patients from being admitted swiftly and undermining safety, he said. “There is not enough money in the system to get social care packages, patients are delayed in hospital who should be at home, there are not enough acute hospital beds.”

The number of patients waiting for more than 12 hours also increased during the spring months, a time when pressures usually start to ease. From April to June 2017, 311 people waited more than 12 hours for treatment. For the same period in 2012, this was the case for only two patients.

Such figures are likely to underestimate the length of time spent in A&E because they only capture waiting times starting from when a decision to admit is made, not when the patient arrives.

“There can be little doubt that patients are suffering the consequences of this reduction,” said Hassan. “Along with more doctors, we desperately need more beds to stop the system from grinding to a halt.”

A Department of Health spokesperson said A&E departments had received an extra £100m to prepare for winter, in addition to £2bn of social care funding.

The spokesperson added :“This analysis completely overlooks the continued rise in demand on A&Es and the fact that since 2010 hardworking NHS staff are treating 1,800 more patients within four hours each day and are seeing 2.8 million more people each year.”

Overstretched hospitals face winter flu crisis, doctors warn

Emergency departments risk “grinding to a halt” this winter, say medical leaders. They warn that the number of patients facing long waits for treatment is likely to hit record levels.

Dr Taj Hassan, president of the Royal College of Emergency Medicine, said staff were dangerously overstretched, as NHS figures showed the number of people waiting more than 12 hours for treatment during the coldest months of the year has soared.

From January to March 2012, 15 patients waited for more than 12 hours – in 2017 this figure was 100 times greater, at 1,597.

Last winter was the worst on record for delays, with nearly 200,000 patients waiting for longer than the four-hour target. Hassan said emergency services will be under even greater strain this year, with patients forced to wait longer for basic treatments such as pain relief.

“Winter last year was relatively mild and without a major outbreak of flu. There are indications that the flu vaccine will not be as successful this year and as such we anticipate that conditions will be even more difficult,” said Hassan. Simon Stevens, chief executive of NHS England, has already put hospitals on high alert following major flu outbreaks in Australia and New Zealand, which it is feared may be repeated in the UK.

An extra 5,000 beds are needed to “to get us through what will be a pretty awful winter”, said Hassan. “Over the last five years there has been a continued reduction in bed numbers yet an increase in patients needing to be admitted. As a result, bed occupancy is now at 92% – significantly higher than the safe level of 85% – which is having a knock-on effect on waiting times.”

A lack of funding, especially in social care, and staff shortages are preventing patients from being admitted swiftly and undermining safety, he said. “There is not enough money in the system to get social care packages, patients are delayed in hospital who should be at home, there are not enough acute hospital beds.”

The number of patients waiting for more than 12 hours also increased during the spring months, a time when pressures usually start to ease. From April to June 2017, 311 people waited more than 12 hours for treatment. For the same period in 2012, this was the case for only two patients.

Such figures are likely to underestimate the length of time spent in A&E because they only capture waiting times starting from when a decision to admit is made, not when the patient arrives.

“There can be little doubt that patients are suffering the consequences of this reduction,” said Hassan. “Along with more doctors, we desperately need more beds to stop the system from grinding to a halt.”

A Department of Health spokesperson said A&E departments had received an extra £100m to prepare for winter, in addition to £2bn of social care funding.

The spokesperson added :“This analysis completely overlooks the continued rise in demand on A&Es and the fact that since 2010 hardworking NHS staff are treating 1,800 more patients within four hours each day and are seeing 2.8 million more people each year.”

Mental health data shows stark difference between girls and boys

A snapshot view of NHS and other data on child and adolescent mental health reveals a stark difference along gender lines.

As reported earlier this week, the results of a study by University College London and the University of Liverpool show a discrepancy between the emotional problems perceived by parents and the feelings expressed by their children. Researchers asked parents to report signs of emotional problems in their children at various ages; they also presented the children at age 14 with a series of questions to detect symptoms of depression.

Graph showing that there is a discrepancy between self-expressed emotional problems in teens and problems reported by their parents


The study reveals that almost a quarter of teenage girls exhibit depressive symptoms. Data from NHS Digital, which examines the proportion of antidepressants prescribed to teenagers between 13 and 17 years old, shows that three-quarters of all antidepressants for this age group are prescribed to girls.

More than two-thirds of antidepressants prescribed to teenagers are for girls


Eating disorders are one of the most common manifestations of mental health problems, and are in some cases closely related to depression. A year-by-year breakdown of hospital admissions for eating disorders indicates that, while eating disorders in both boys and girls are on the rise, more than 90% of teens admitted to the hospital for treatment are girls.

Graph showing the difference between girls and boys admitted to hospital for eating disorders

Records also show hospital admissions dating back to 2005 for individuals under 18 years old who committed self-harm. While the numbers for boys have seen a smaller amount of variation with a general upward trend, the figure for girls has climbed sharply during the last decade, with the most significant jump occurring between 2012/13 and 2013/14.

Hospital admissions for self-harm are up by two-thirds among girls


Two of the most common methods of self-harm are poisoning and cutting. Self-poisoning victims are about five times as likely to be girls, and the number of girls hospitalised for cutting themselves has quadrupled over the course of a decade.

Most self-harm admissions involve cases of self-poisoning, which has risen drastically among girls
Self-harm hospitalisations involving girls cutting themselves have quadrupled since 2005


Although self-harm, depression, and other mental health problems are more commonly reported and identified in girls, suicide rates are far higher among boys. This data is consistent with research on differences found between men and women in methods used to commit suicide, the influence of alcohol, and other social or cultural factors.

Teenage boys are more than twice as likely to kill themselves as girls
  • In the UK the Samaritans can be contacted on 116 123. In the US, the National Suicide Prevention Lifeline is 1-800-273-8255. In Australia, the crisis support service Lifeline is 13 11 14. Other international suicide helplines can be found at www.befrienders.org.

Body’s ‘bad fat’ could be altered to combat obesity, say scientists

“Bad fat” could be made to turn over a new leaf and combat obesity by blocking a specific protein, scientists have discovered.

Most fat in the body is unhealthy “white” tissue deposited around the waist, hips and thighs. But smaller amounts of energy-hungry “brown” fat are also found around the neck and shoulders. Brown fat generates heat by burning up excess calories.

Now scientists experimenting on lab mice have found a way to transform white fat into “beige” fat – a healthier halfway stage also capable of reducing weight gain.

Dr Irfan Lodhi, from Washington University School of Medicine in the US, said: “Our goal is to find a way to treat or prevent obesity. “Our research suggests that by targeting a protein in white fat, we can convert bad fat into a type of fat that fights obesity.”

Beige fat was discovered in adults in 2015 and shown to function in a similar way to brown fat. Lodhi’s team found that blocking a protein called PexRAP caused white fat in mice to be converted to beige fat that burned calories.

The discovery, published in the journal Cell Reports, raises the prospect of more effective treatments for obesity and diabetes. The next step will be to find a safe way of blocking PexRAP in white fat cells in humans.

Lodhi said: “The challenge will be finding safe ways to do that without causing a person to overheat or develop a fever, but drug developers now have a good target.”

Body’s ‘bad fat’ could be altered to combat obesity, say scientists

“Bad fat” could be made to turn over a new leaf and combat obesity by blocking a specific protein, scientists have discovered.

Most fat in the body is unhealthy “white” tissue deposited around the waist, hips and thighs. But smaller amounts of energy-hungry “brown” fat are also found around the neck and shoulders. Brown fat generates heat by burning up excess calories.

Now scientists experimenting on lab mice have found a way to transform white fat into “beige” fat – a healthier halfway stage also capable of reducing weight gain.

Dr Irfan Lodhi, from Washington University School of Medicine in the US, said: “Our goal is to find a way to treat or prevent obesity. “Our research suggests that by targeting a protein in white fat, we can convert bad fat into a type of fat that fights obesity.”

Beige fat was discovered in adults in 2015 and shown to function in a similar way to brown fat. Lodhi’s team found that blocking a protein called PexRAP caused white fat in mice to be converted to beige fat that burned calories.

The discovery, published in the journal Cell Reports, raises the prospect of more effective treatments for obesity and diabetes. The next step will be to find a safe way of blocking PexRAP in white fat cells in humans.

Lodhi said: “The challenge will be finding safe ways to do that without causing a person to overheat or develop a fever, but drug developers now have a good target.”

Adult social care is in crisis mode. We need a clear long-term plan | Joel Charles

This party conference season, all political parties will use their platforms to set out a post-election vision. Adult social care was one of the big general election issues, and the government has indicated that an adult social care green paper is likely next year. The next few months are critical for capturing the views of the public, the health and care sectors and charities working to support older people.

At Future Care Capital, we have launched a new policy report about the challenges facing our ageing society and the implications for every generation. Addressing three key themes – intergenerational fairness and the economics of ageing, health and care futures, and planning ahead – we invited leaders from the public, private and third sectors to contribute. They considered how policies and spending decisions that impact health and care outcomes could better reflect the challenges and opportunities we can expect in the next five, 10 and 15 years.

Our report also calls for a more concerted effort to in the short-term to adapt homes and public spaces for age and mobility, as well as recognition of the contribution of carers to the economy and measures to improve their work-life-care balance.

What’s striking is the consensus that there is no long-term plan for health and adult social care and that the result is a growing care deficit. Our health and care services are facing a perfect storm; the country’s population is getting older and the number of care workers is insufficient to meet future demand. At the same time, 10% of people already identify as unpaid carers, which has implications for their work-life-care balance and the wider economy. Tackling the problem in isolation is not an option. The government needs to collaborate with communities, service commissioners and providers, and charities and innovators to forge a way forward.

A new settlement for health and care or a “care covenant”, underpinned by our future care guarantees, could offer greater security to everyone. These guarantees call on the government to introduce a new funding formula for health and care services, to champion independent living by investing in pre-care measures and education to build a bigger care workforce.

One key issue is a general lack of understanding among the public about the scope of state-funded adult social care services and who should pay for them.

Some 67% of 16 to 75-year-olds agree that people should be required to plan and prepare financially for later life, while 49% agree they should have to plan and prepare financially for adult social care services they might need, according to a survey we conducted with Ipsos Mori.

In addition, it found many people support a range of income tax rises to increase the amount of funding available for adult social care. Raising the additional rate from 45p to 50p was supported by 58% of those surveyed, increasing the higher rate from 40p to 43p by 57%, and half backed a raise in 1p of the basic rate.

What’s more, 76% of those surveyed said increasing the number of health and social care workers would ease pressure on the system, and 71% thought that providing greater support for unpaid carers would be effective.

Our ageing society represents one of the biggest human challenges of our time – every family is affected. We need political consensus on our direction of travel – a long-term plan to guide the policies of successive governments to improve health and care outcomes and enable people to plan ahead. Otherwise, we will remain in fire-fighting or crisis mode. The government’s forthcoming green paper affords it a prime opportunity to act now and build health and care provision fit for everyone in our society.

Joel Charles is deputy chief executive of Future Care Capital

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NHS spends £80m on private ambulances a year, data shows

The NHS is spending almost £80m a year hiring private ambulances to answer 999 calls and take patients to hospital for appointments, new figures show.

Widespread shortages of paramedics and rising demand forced England’s 10 NHS ambulance trusts to spend £78.4m in 2016-17 on help from non-NHS providers to supplement their own services. That was down on the £79.7m trusts spent in 2015-16, but 22% more than their £64.2m outlay in 2014-15, according to data obtained by the Press Association under freedom of information laws.

South Central ambulance service spent the most on private services last year – £16.3m, up from its £13.6m outlay the year before and £12.3m in 2014-15.

The East of England ambulance service spent the second-largest amount: £14m, more than double the £6.6m it paid to non-NHS providers the year before. The South East Coast ambulance service spent £11.1m.

A spokesman for the Independent Ambulance Association (IAA) said the main reasons for a rise in private ambulance use in the last two years were “staff shortages in NHS ambulance trusts, combined with continued increases in demand”.

The benefits of using independent firms include flexibility and good value for money as “it’s cheaper for the NHS than paying overtime”, he added.

Jonathan Street, a spokesman for the College of Paramedics, said NHS ambulance staff were “under heavy pressure due to growing numbers of 999 calls”.

He added: “These services are increasingly reliant on paramedics and other ambulance clinicians within the private sector to meet the demand, which involves considerable cost.”

The disclosures sparked concerns that ambulances supplied by profit-driven firms may provide a lower standard of care than that provided by crews employed by the NHS.

“The huge sums spent on private ambulance services expose the pressures on staff due to soaring demand. Experienced and highly trained employees are leaving because of the strain,” said Alan Lofthouse, Unison’s national ambulance officer and a former paramedic.

“Paying agency workers to fill the gaps is putting patient safety and the wellbeing of crews at risk,” he claimed.

Norman Lamb, the Liberal Democrats’ health spokesman, said the rising spend on private ambulances was a shocking stain on the government’s NHS record.

“Ambulance services are simply not being provided with the resources or staff needed to cope with soaring demand. Growing reliance on private sector services is not only costly, inspections have also raised serious concerns over patient safety,” said Lamb.

However, the IAA insisted that the standard of care was “no different” to that offered by the NHS, and that all providers are registered with the Care Quality Commission and subject to the same inspection standard as NHS ambulance trusts.

Private ambulances are hired from private firms as well as charities such as St John Ambulance and the Red Cross.

Dr Taj Hassan, president of the Royal College of Emergency Medicine, which represents A&E staff, said: “It is concerning that trusts are having to use part of their budget for private ambulances, and serves to highlight the current levels of demand emergency departments are facing.”

Hassan also voiced unease about the quality of training private firms provide to their staff, leaving them ill-prepared for treating patients.

“The Care Quality Commission has previously highlighted that they may use less qualified staff or staff whose qualifications aren’t regulated or restricted,” he said. “They may be poorly equipped, have poor clinical governance, poor infection prevention, and a lack of or inappropriate equipment.”

Surgeons lacked caution in use of vaginal mesh implants, doctor admits

The corporate giant Johnson & Johnson says it acted “ethically and responsibly” in developing and selling its controversial transvaginal mesh implants, which have left hundreds of Australian women with chronic and debilitating pain.

A Senate inquiry is currently examining the impact of transvaginal mesh products, which are used to treat urinary incontinence and pelvic prolapse, common complications of childbirth.

The devices have caused life-altering complications in many cases, leaving women in severe pain and unable to have sexual intercourse.

The inquiry heard from two women whose lives have been destroyed by post-surgery complications – Gai Thompson, who had her surgery in 2008, and Joanne Maninon, who had the device implanted in 2012.

Both struggled with tears as they spoke of the impact the devices have had on their lives.

Maninon said she was told the mesh would make her feel like a “16-year-old virgin” and that she would be back at the gym in 10 days.

“To this day, I can’t sit upright on a chair for longer than 15 minutes at a time due to the searing, burning pain that travels across my lower abdomen and into my pelvis,” she said.


I describe my pain as being cut open and set alight

Joanne Maninon

Maninon was completely bedridden for 14 weeks due to the agonising pain. She wasn’t able to leave the house for months. To get to the doctor, Maninon lay down on a mattress in the back of a station wagon.

“I describe my pain as being cut open and set alight,” Maninon said. “A deep burning, searing ache that intensifies with movement.”

Later on Monday, the inquiry heard from Gavin Fox-Smith, the managing director of Johnson & Johnson Medical Australia and New Zealand.

Fox-Smith offered an apology to “patients who have not experienced a successful outcome from their treatment”.

But he said he believed the current Australian class action against the company would vindicate its actions.

“We believe the evidence will show we have acted ethically and responsibly in the research, development, and supply of the products that are the subject of the proceedings,” Fox-Smith said.

Asked whether the victims’ stories had affected him personally, Fox-Smith replied:

“Thats a pretty personal question senator, so I’ll give you a personal answer,” Fox-Smith said.

“It’s really, really hard to even conceptualise the challenge that the patients are facing. And for me, honestly I’ve had the privilege of working in this industry for 30 years. Our job is to make patients better, so for me it’s really tough, it’s nowhere near as tough as what the patients have to deal with,” he said.

Earlier, Urogynaecological Society of Australasia director, Jenny King, told the inquiry there had been a lack of caution around the use of the devices. Surgeons, she said, thought they were “magic”.

But King labelled any attempt to ban the controversial devices as “hysterical”, saying they had positive outcomes for women who were unable to undergo other major surgery. She instead said doctors should be more careful in their use, avoiding operations on younger and healthy women.

“The impacts that these have had on these women – we have seriously let them down,” King said.

“But what phases me about this is the suggestion that the solution is to ban vaginal mesh products so that other people don’t suffer,” she said.

“I don’t want to defend all of my colleagues, but we’re not really callous. We don’t like it when we can’t fix everyone, we’re really bad at that.”

Estimates vary on the number of women who have experienced problems with the implant. King said about 5% of cases caused problems. Other estimates suggest a higher rate of 10-15%.

The use of the mesh had dropped by 90% in recent years, since concerns became public.

King said the controversy had made her “timid” in her use of the devices. She regretted not using the mesh in some circumstances, because it required women to eventually undergo multiple surgeries.

The cases, seen across the western world, have prompted significant criticism of manufacturer, pharmaceutical giant Johnson & Johnson. The company is currently being sued in a class action in Australia.

The Australian trial has heard the company embarked on an aggressive marketing campaign to sell the products to surgeons, promising they were easy to insert, inexpensive and therefore lucrative. Advertisements associated the products with Lamborghinis and trips to the Swiss Alps.

The risks of the devices were downplayed and controlled trials were either nonexistent or insufficient, the court has heard.

The court also heard the company tried to stop French health authorities publishing a report warning against the use of its untested pelvic mesh devices, two years after they began giving them to Australian women.

Senator Derryn Hinch, who has campaigned against the mesh devices, asked King if Australian surgeons were offered incentives to use the devices.

“No love, truly I’ve never seen anything like that,” she responded. “Nobody’s ever given me one. I would hate to think that had happened, and I don’t know of it, truly.”

The inquiry is considering several courses of action on the mesh. One is to ban the device outright. Another is to introduce a mandatory reporting regime, which forces doctors to report adverse impacts on patients. The inquiry heard there was significant under reporting of adverse consequences on women.

A third is a credentialing system, which would ensure surgeons were appropriately qualified to conduct such surgeries.

It is also considering a recommendation to build a tracking database to monitor the use of different mesh products on patients.

This week it was revealed that Johnson & Johnson pulled two controversial pelvic mesh devices from the Australian market.

The decision came after Australia’s Department of Health required further evidence of the devices’ safety.